When nine-year-old Rob Cole, child of poor 11th-century
English farmers, loses his mother, he is consigned to the care of a
barber-surgeon who takes him around the countryside, teaching him to juggle,
sell potions of questionable value, and assist him in basic medical care that
ranges from good practical first-aid to useless ritual. When, eight years later, his mentor dies, Rob
takes the wagon, horse, and trappings and embarks on a life-changing journey
across Europe to learn real medicine from Avicenna in Persia. Through a Jewish physician practicing in
England, he has learned that Avicenna’s school is the only place to learn real
medicine and develop the gift he has come to recognize in himself. In addition to skill, he discovers in
encounters with patients that he has sharp and accurate intuitions about their
conditions, but little learning to enable him to heal them. The journey with a caravan of Jewish
merchants involves many trials, including arduous efforts to learn Persian and
pass himself off as a Jew, since Christians are treated with hostility in the
Muslim lands he is about to enter.
Refused at first at Avicenna’s school, he finally receives help from the
Shah and becomes a star student. His
medical education culminates in travel as far as India, and illegal ventures
into the body as he dissects the dead under cover of darkness. Ultimately he marries the daughter of a
Scottish merchant he had met but parted with in his outgoing journey, and,
fleeing the dangers of war, returns with her and their two sons to the British
Isles, where he sets up practice in Scotland.

This thoughtful essay from the author of The Emperor of All Maladies expounds on information, uncertainty, and imperfection in the medical setting. The author recalls witnessing a difficult operation when he was a medical student. The attending surgeon admonished the operating room team, "Medicine asks you to make perfect decisions with imperfect information" (p.5). This essay is constructed around that idea as the author shares three personal principles that have guided him throughout his medical career. Law One: A strong intuition is much more powerful than a weak test. (p. 22) Law Two: "Normals" teach us rules; "outliers" teach us laws. (p. 38) Law Three: For every perfect medical experiment, there is a perfect human bias. (p.54)

He views the medical world as a "lawless, uncertain" place and stresses that biomedicine is a "softer science" than chemistry or physics. Clinical wisdom, in his opinion, is imperfect, fluid, and abstract whereas the knowledge base of other basic sciences is concrete, fixed, and certain. He laments, "My medical education had taught me plenty of facts, but little about the spaces that live between facts" (p. 6).

His own "laws" of medicine are actually laws of imperfection. Clinical diagnosis can be thought of as a "probability game" where human bias creeps into the process. And ultimately common sense trumps pure statistical reasoning. Woven into the discussion are considerations on a variety of topics - children with autism, Heisenberg's uncertainty principle, genomics, radical masectomy, and randomized, double-blind studies. Nods to Lewis Thomas (The Lives of a Cell: Notes of a Biology Watcher), Thomas Bayes (Bayes' Theorem), and Johannes Kepler (Kepler's Laws of planetary motion) fit in nicely with the thrust of the treatise.

Born into a Montreal Jewish family in 1924,
Richard Goldbloom was always sensitive to minorities and at ease with
difference. Jewish and Christian, French and English, music, theatre, and the
arts in all forms were prevalent and valued in the family home. He became a
skilled pianist and a gifted storyteller. Richard trained in medicine with his
father and at McGill University then specialized in pediatrics at Harvard
with the famous Charles A. Janeway at Boston Children’s Hospital.

He met the vivacious, intrepid Ruth
Schwartz at McGill when they both auditioned for a play. Also Jewish, she hailed
from Cape Breton Island, Nova Scotia. They married in 1945 before his studies
were complete and had three children. Unlike many male physicians of his era, Richard
was in awe of this tiny dynamo and attributes his happiness and success to her.

In 1967, the family moved to Halifax, Nova
Scotia, where Richard became Professor of Pediatrics, Physician in Chief and
director of research at the new children’s hospital. Ruth was instrumental in a
wide array of philanthropic endeavors that inevitably involved her husband. She
developed a remarkable museum at Pier 21, the point of arrival for generations
of immigrants to Canada—a place to gather their stories and their achievements.

Many anecdotes about clinical practice and
scientific innovations are told with accessible enthusiasm and gentle humor. He
dispels myths, exposes hidden agendas and explains with clear examples the
importance of listening to children and their parents. Underlying the entire
narrative is a refreshing humility and gratitude for his “lucky life.”

This memoir focuses on the various ways in which his being
an African American affected Tweedy’s medical education and early practice as a
medical resident and later in psychiatry. Raised in the relative safety and
privilege of an intact family, he found himself underprepared for some of the
blatant forms of personal prejudice and institutional racism he encountered in
his first years of medical education at Duke Medical School. One shocking moment he recounts in some
detail occurred when a professor, seeing him seated in the lecture hall,
assumed he’d come to fix the lights.
Other distressing learning moments occur in his work at a clinic serving
the rural poor, mostly black patients, where he comes to a new, heightened
awareness of the socioeconomic forces that entrap them and how their lives and
health are circumscribed and often shortened by those forces. Well into his early years of practice he
notices, with more and more awareness of social contexts and political forces,
how the color line continues to make a difference in professional life, though
in subtler ways. The narrative recounts clearly
and judiciously the moments of recognition and decision that have shaped his
subsequent medical career.

Not God is a "play in verse" with two characters, a hospitalized patient and the patient's doctor. The scare quotes indicate the fluid quality of Not God, which the author originally conceived as a sequence of poems spoken in a patient's voice. Subsequently, he added the doctor poems (monologues) to create a "dialog" between the two voices. Once again, scare quotes suggest the atypical quality of this dialogue, since the two characters express different feelings and perspectives on the situation, but do not directly address one another. The play version has received several performances at colleges and small theaters.The patient speaks first in a monologue that begins "A man's cough bounces down the hallway / like pick up sticks... " and ends with "I am here two weeks." (p. 7) It soon becomes evident that he/she has cancer and is receiving chemotherapy. The doctor has changed this person's life by speaking "one word," after which "nothing / would ever be the same again." (p. 10). The patient is knowledgeable, accepting of his/her condition, a keen observer with a good sense of humor, as in "Doldrums" (p. 19) and "Cricket" (p. 23), and a person who affirms life in spite of adversity. The doctor is burdened with the power of medical knowledge. In particular, he understands the deadly meaning of signs and symptoms: "We say / excess water and swelling of the belly, knowing / full well... / an ovarian cancer is almost certain." (p. 33) But the meaning this represents is chaos: there is nothing humane or transcendent about cancer. Unlike his baseball card collection in childhood ("Shoebox," p. 35), cancer is neither confined nor orderly. In the second act, the patient sympathizes with the doctor whose "head is so cluttered / with obligatory data." Paradoxically, the doctor must be protected because he is "filled with dying." (p. 41) The doctor becomes angry with the burden, "Why / ask me a question that only God can answer?" (p. 49) and cries out that his work is "alchemy, / potions and witches' brews." (p. 54) In the end, while dying, the patient imagines "a bridge that can cross / the Atlantic." (p. 68), while the doctor speaks a prayer, "The word cure, dear God, is always / near my lips, though I have been constrained from / saying it aloud." (p. 66)

In this collection (80 pages), Marc Straus speaks of the inadequacy of communication and knowledge in medicine; the pauses, the distance, the hesitations. You think you know what you are doing, "But no, they always ask the question / I never knew." ("The Log of Pi") "The question / might be so simple, so clear / that you’re unprepared to answer." ("Questions and Answers") Though words are in one way inadequate, the medical word carries great power: " . . . I knew that moment / I would say one word for her and nothing / would ever be the same again." (One Word, annotated in this database.)The poet comes to understand that he represents both sides of medicine, both the detached and distant Dr. Gold, and the warm and trustworthy Dr. Green. (See annotation of Dr. Gold & Dr. Green) Unfortunately, this knowledge only comes about after the patient has died ("Dr. Gold & Dr. Green, II"). We learn from experience, sometimes too late.

The speaker reflects that "life is sometimes reduced / to a single word . . . . " He remembers one incident at a bus stop, another interviewing a man "for a job in my lab." Then there was the time a woman "walked / into my office for one thing . . . . " He discovered a "fullness" in her neck and knew that the word he would say to her, the one word, would change her life: "nothing / would ever be the same again."

This fine collection of work by Audrey Shafer is subtitled "Poems by a Doctor/Mother." The book begins with a section containing poems of personal history and experience ("that I call home"), descends into the nether world of anesthesia ("not quite sleep"), and in the final section returns to the light with a new perspective on the texture and occurrences of ordinary life ("okay for re-entry").Among the more medically oriented poems, see especially "Spring," "Anesthesia," "Three Mothers," Monday Morning (see annotation in this database), "Gurney Tears," "Center Stage," and "Reading Leaves." "Don’t Start, Friend" takes up the topic of substance abuse among anesthesiologists (or physicians, in general).

The author, an experienced surgeon, believes that we will be less frightened by the prospect of death if we understand it as a normal biologic process. He points out that 80 percent of deaths in this country now occur in hospitals and are therefore "sanitized," hidden from view, and from public comprehension. He describes the death process for six major killers: heart disease, stroke, AIDS, cancer, accidents/suicide, and Alzheimer's disease.But the power of the book is in its intensely personal depiction of these events and in the lessons which Nuland draws from his experiences. The message is twofold: very few will "die with dignity" so that (1) it behooves us to lead a productive LIFE of dignity, (2) physicians, patients, and families should behave appropriately to allow nature to take its course instead of treating death as the enemy to be staved off at any cost. Only then will it be possible for us to die in the "best" possible way--in relative comfort, in the company of those we love/who love us.

The author, Professor of Psychiatry at Johns Hopkins University School of Medicine, is an authority on manic depressive illness. With this powerful, well-written memoir she "came out of the closet," publicly declaring that she herself had suffered from manic depressive illness for years. Jamison describes the manifestations of her illness, her initial denial and resistance to treatment with medication, attempted suicide, and her struggle to maintain an active professional and satisfying personal life.The author was "intensely emotional as a child," (p.4) and in high school first experienced "a light lovely tincture of true mania" (p.37) during which she felt marvelous, but following which she was unable to concentrate or comprehend, felt exhausted, preoccupied with death, and frightened. (pp. 36-40) Interested in medicine as an adolescent, she pursued her goal in spite of mood swings and periods of mental paralysis. Jamison completed graduate work in clinical psychology; shortly after obtaining a faculty appointment "I was manic beyond recognition and just beginning a long, costly personal war against a medication that I would, in a few year’s time, be strongly encouraging others to take [lithium]." (p. 4)Jamison eventually, through strong support from friends and colleagues, excellent psychiatric care, and her own acceptance of illness, has been able to reach a state of relative equilibrium--tolerable levels of medication (fewer side effects) and dampened mood swings. But she makes clear that she must stay on lithium and remain vigilant.